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Friday, September 28, 2012

Pregnancy after 35

KATHMANDU: Get married soon, time is running out, if you marry late (30’s is the dreaded age), you won’t be able to conceive’ — such naggings never stop till the daughter succumbs to parents’ wishes. But is it true? Is it risky to conceive when you are in your 30’s? Society says yes, but the doctor disagrees.

“It is not true. The egg count will lessen as you age, but there is a possibility to become pregnant,” clears Dr Bimala Lakhey, Sr Consultant Obstetrician Gynaecologist.

Despite this information people may still be sceptical as old habits die hard. Therefore, relating to the pressures a woman faces, is it a good idea to become pregnant during mid 30’s? Nepali society is such that many women are financially dependent on their husbands, so if a woman marries late followed by pregnancy, it is a sound decision. “If a woman opts to be pregnant in her 30’s, then she is emotionally ready to handle the responsibility and is financially secure, so I support this decision,” encourages Dr Lakhey.

Some risks

With this you also have to understand that till the age of 35 there won’t be any problems as such, but after that there can be complications, which should be noted.

Some risk or complications are —

• Low birth rate.

• Chances of miscarriage — “If in 20’s chances of miscarriage is 25 per cent, in 40’s it is double due to chromosomal abnormality,” says Dr Lakhey.

• Child can suffer from Down’s syndrome.

• As the egg count is less in this age group, becoming pregnant may take longer.

• Chances of having twins increase. “This is because of egg increasing medicine.”

• Developing high blood pressure, which is an age factor.

“Nonetheless, it is not alarming though comparatively to younger age, the complications can be more,” adds Dr Lakhey. There are treatments and diagnosis that can deal with such issues.

Also good health will help before you conceive, for which you need to eat food with folic acid content “present in green vegetables”, a balanced diet also becomes important, limiting your caffeine consumption, exercising regularly, not drinking alcohol and not smoking.

Talking about pregnancy, the role of the biological father is also important to mention. “If the father is more than 50 years old, then the child born will have chances of being autistic,” says Dr Lakhey.

So what after the pregnancy?

“She has to be alert about the diabetes and has to be under constant medical supervision, also screening test should be conducted to check chromosomes,” answers Dr Lakhey.

Other than that one need not worry.

Boon of medical


When one door closes, the other opens. If it doesn’t work naturally for you, then there is an alternative — In Vitro Fertilisation (IVF).

So who should opt for this process? “There are many indications for IVF,” says Dr Uma Shrivastava, Infertility and IVF Specialist and Director at Infertility Centre, Bijulibazar, New Baneshwor which are —

1. If both the fallopian tubes are blocked.

2. Male infertility

3. Failed IVF

4. Failed conventional treatment

5. Failed ovulation

6. Endometriosis

7. Unexplained infertility

This is definitely a boon of medical science, but Dr Shrivastava asserts that it shouldn’t be fashion, which is the trend these days. This process is a blessing for many, but to understand every aspect is also equally important. There are complications of IVF, “which should be highlighted,” asserts the doctor, such as —

• Multiple pregnancy

• Ovarian Hyperstimulation Syndrome (OHSS) in Polycystic Ovarian Syndrome (PCOS), “which can also lead to death,” warns Dr Shrivastava.

• Other hormonal complications like increasing cyst and failed stimulation, “where after one IVF, the woman can go into early menopause”, which means she can never become pregnant.

The more knowledge you have, the better decisions you can make. Therefore, before opting for IVF, proper hormone test is vital. You have to first visit the hormone specialist known as endocrinologist. After s/he gives the green signal, then it is the gynaecologist’s job and so the process moves forward.

However, not everyone can opt for IVF. If you have inactive ovary, do not think about IVF instead “you should take a donor egg,” suggests Dr Shrivastava. Another case is — if you have tumour in your uterus, an alternative for such women can be “surrogacy”.

Every woman at some point of her life wants to be a mother, when she is ready. Or what is wrong if she doesn’t want to be pregnant? More than science or societal pressure, ultimately the choice should to be hers!

Article Published on The Himalayan Times

Thursday, September 27, 2012

Protocol for Infertility Treatment in Nepal

KATHMANDU: Health experts today suggested for a practical protocol on infertility to handle legal, ethical and technological issues.

The Ministry of Health and Population is drafting the ‘Protocol for Infertility Management in Nepal’ to determine necessary investigations of underlying cause of infertility and for the management of infertility by conventional methods.

Dr Uma Shrivastava, reproductive endocrinologist at Infertility Centre Nepal, said the protocol is essential for the management of infertility by Artificial Reproductive Technologies and for managing the complication of infertility treatment. In addition, the policy is also essential to follow the common procedure by health personnel to identify and treat the cases of infertility.

After identification of the underlying cause, treatment should be managed according to the available facility in rural or urban areas. For unavailable necessary treatment, cases should be referred to the appropriate centres for proper management, said the endocrinologist.

According to Dr Shrivastava, the infertility is estimated to affect about 10-15 per cent of Nepali population.

About one third of infertility cases are due to male factors, other one third due to female factors and the remaining third due to combination of both male and female factors, she said. The origin of the condition of about 20 per cent cases is unidentified or unexplained.

Infertility is more of a social priority than an individual’s need. In most ethnic communities, it is accepted as a defect in the female partner, even though male partners contribute equally, said Dr Shrivastava.

Due to joint family trend, women are emotionally distressed as a consequence of infertility. Therefore, she said, the treatment should target more on counseling the couple about their personal, social and marital distress before their cure.

Chances of infertility are higher in couples who have gone through abortion. The country has recorded 95,000 abortions in the fiscal year 2010/11.

Dr Babu Ram Marasini, chief of the health sector reform unit at the ministry, said the policy is going to incorporate legal issue of surrogate mother, biological father, test tube baby and other ARTs within it.

ARTs are methods used for fertilisation or making women pregnant by artificial means in case of infertility.

This method is also used in fertile couples for genetic reasons. Some of the ART methods practiced in Nepal are Artificial Insemination of Husband, Artificial Insemination Donor and In Vitro Fertilisation.

The country does not have any legal backing for surrogate mother, biological father and ARTs which can create a problem regarding property right, citizenship rights and protection rights in near future, said Dr Marasini.

Pregnancy followed by ARTs could bring many ethical and legal challenges in the country. The government should give the mandate to carry out the procedure for Test tube babies or IVF, he added.  
Article Published on The Himalayan times dated 6/7/2012